IMMIGRATION AND THE PUBLIC HEALTH 335 



IV. Depoktation of Unsound Landed Aliens 



But the exclusion of unsound aliens includes more than a competent 

 medical examination at entrance. Many cases of incipient disease 

 both physical and mental are unrecognizable at the time of entry except 

 by detailed and refined methods of diagnosis which are absolutely 

 impracticable in the routine examination of large numbers of immi- 

 grants. Also the cleverness and cunning of defective aliens may easily 

 conceal from the examiner some unobtrusive though important sign of 

 defect or disease. Such cases are very apt to come to light sooner or 

 later after landing; in hospitals or other public institutions. As Dr. 

 Friedman says: 



The detection of mental disease among aliens offers the same difficulties in 

 an infinitely larger degree. The goal in this work is to be able to detect from 

 the panorama of people those who have remote or only latently present mental 

 abnormalities. There are no signs by which an examiner can say in any given 

 instance that an individual will develop a mental disease. 



In addition it is impossible for an examination at the time of 

 arrival to indicate how successfully a given immigrant will react to the 

 stress and strain of American life, and whether some latent tendency 

 or weakness may not be developed under the new conditions. In short 

 the medical examination at entrance must be supplemented by exam- 

 ination at a period later in case some latent disease manifests itself. 



The law takes cognizance of these circumstances by providing for 

 the deportation of aliens who., within three years of landing, become 

 public charges or develop any of the excludable diseases from causes 

 existing prior to landing. An example of the need of this law and of 

 its operation may be seen in the case of pulmonary tuberculosis, due to 

 causes present when the alien landed but not appearing in definitely 

 recognizable form until months later. 



Even more striking is the value of this law in insanity, epilepsy and 

 mental defectiveness. These conditions are excludable but often escape 

 detection on the primary examination. Within the three-year limit, 

 however, a large number of such cases develop. Many forms of insanity 

 and epilepsy are known to be due to hereditary constitutional defect 

 and psychopathic tendencies. Hence if one of these becomes apparent 

 within three years after landing, the diagnosis shows that the causes 

 must have existed prior to landing. Of course feeble-mindedness, idiocy 

 and imbecility are congenital and one of these conditions found within 

 three years is evidently under the law. 



Feeblemindedness differs from imbecility only in degree, and in its 

 lesser forms in turn shades off into simple backwardness of mental de- 

 velopment. A case may have been given the benefit of the doubt on the 

 primary examination, when later conditions indicate it to be feeble- 

 minded. An infant or young child may show feeble-mindedness within 



